HOLIDAY MAILERCOMPLETE THE INFORMATION REQUESTED BELOW AND

FAX THIS ORDER FORM TO (724) 684-6442

GIFT CERTIFICATE INFORMATION (PLEASE PRINT)

Clinic Name

DoctorÕs Name (please print clearly how the name should appear)

Address

City State/Prov. Zip/Postal

Telephone # Fax #

Email Address for proofing purposes:

Dollar Value of Service Expiration Date

State Disclaimer Needed? : nn Yes nn No Medicare rules apply Needed?: nn Yes nn No

Certificate Applies To

All information above is correct. I understand that I am responsible for its accuracy and legibility. The Doctor has the right to cancel the order and receive full pay-ment within 72 hours of placing this order. Cancellations after proof approval will not be accepted. There will be no refunds for cancelled jobs after the 72 hour period. A credit will be issued to your account for future purchases of either stock or imprinted items.I will be paying for this by:nn MasterCard nn Visa nn American Express nn Discover nn Check #

Credit Card No. Expiration Date

Authorized Signature CCS Code

Out on Proof Revisions nn OK TO PRINT

Holiday Mailers

Patient Flyers

Holiday Posters

Date

Each set includes: one card with envelope blank inside, cover letter, and gift certifi-cate for your patients to give to friends or relatives.THROUGH OCTOBER 31ST100 sets $165.00 each additional: $1.08 per set200 sets $225.00 each additional: $1.08 per set500 sets $495.00 each additional: $1.99 per set1,000 sets $831.00 each additional: $1.83 per setAFTER OCTOBER 31ST100 sets $185.00 each additional: $1.18 per set200 sets $242.00 each additional: $1.18 per set500 sets $535.00 each additional: $1.07 per set1,000 sets $913.00 each additional: $1.91 per setPATIENT FLYERSFREE with purchase of holiday mailer (50 free for 100 sets, 100 free for 200 sets, etc.) each addi-tional 100......$28

PROMOTIONAL POSTERSONE FREE with purchase of 200 or more holiday mailers. Each poster is $8

CARD DESIGN nn GIFTS UNDER TREE nn

INSIDE OF CARD BLANK IS STANDARD nn ADD MESSAGE (CALL FOR INFO)LETTER VERSION nn STANDARD nn WITH WEIGHT LOSS

l.k. graphic communications1.800.548.3676 www.lkgraphics.com

TotalQuantity

Sub-Total

Shipping

Total $$25 per 100 when you order with your holiday mailer